ry ry . Dr. N. Ravindra Shetty Orthopaedic Surgeon, discussing - - PowerPoint PPT Presentation

ry ry

.

• Dr. N. Ravindra Shetty Orthopaedic Surgeon,

discussing Anyuta - Pilot Project – Karnataka, with Honorable President of India Abdul J. Kalam, at Bangalore on 20th August 2005,

COST DIFFERENCE

Name e of the Patient ient Illne ness Hospita tal Bill Specialt ialty Super r Specialt ialty Differen erence Apollo BGS Narayana Jayadeva Kidwai Nephro Urology Medical College hospitals

Please se check every ery file for all the criter eria written en here e under Check eck List for Policyhol yholder der Policy y Details Hospital Details. Main Bill.

• 1. Policy

y Cop (Sum Insured red / validity) y)

• 1. Name the Primary Doctor.

(Mobile/ Landline Number/ E – mail / Website)

• 1. Break up of Final Bill.
• 2. Claim Form.

(Sign gned ed by Policyhol holder) der)

• 2. Name the Specialists.

(Mobile & Landline Number)

• 2. Receipts of all bills.

(Signed by the Doctor / Patient) 3.Cop

• py

y of the ID Card.

• 3. Investigations ordered and the Reports - Signed by Specialists in the Specialty.

(Name, Qualification, Registration number)

• 3. Advance paid receipt.
• 4. Name

e of the Insurance e Co.

• 4. Doctor’s Prescription / dispensed Medicine Bill

(Signed by the qualified Pharmacist (Name, Qualification, Registration number)

• 4. Anyuta – Payment details.
• 5. Zone/

e/Divi visi sion

• n/Bra

ranch

• 5. Discharge Summary in Anyuta Format

(Diagnosis, ICD Code, Treatment given, Follow up instructions)

• 5. Covering letter.
• 6. Con
• ntact number.

ber.

• 6. Contact number.
• 6. Contact number.
• 7. E- Mail addres

ess. s.

• 7. E- Mail address.
• 7. E- Mail address.
• 8. Policy

y Limit

• 8. Pre – authorization request - Copy
• 8. Discount Offered
• 9. Anyuta TPA Authorization Letter for Cashless facility - Copy

ANYUTA - TPA ABY Claim Settlem emen ent Format : CCN PLEASE MENTION REIMBURSEMENT/CASHLESS PLEASE MENTION PREVIOUS CLAIM DETAILS ( IF ANY) Total Sum insured REIMBURSEMENT Available Balance HOSPITAL NAME CLAIMED DOA DOD Room Stay ICU Stay CLAIMED AMOUNT RS./-, BILLS / MEMOS ATTACHED RS.0/-, PAID BY PARTY RS.REIMBURSEMENT/-. CODE DATE BILL NO SERVICES CLAIM DISCOUNT DEDUCTION PAYABLE DOCTOR'S REMARK Name Age / Sex Employ

• ymen

ent No. Aadaha haar Card Number er Contact No Summary Diagnos nosis Treatmen ent given Procedur edure e done Cost incurred ed Doctor

• rs Fee

Medicine ne Surgical Sundries es Medical sundries es CGHS Medicine ne Code CGHS Investigation

• n Code

CGHS Blood d Test Code Implant nts Total Cost Packa kage e CGHS Code Packa kage e Rate Signatur ure e of the Hospital author

• rity

NOTE: CGHS has separate e rates for Consul ultation/

• n/ Investigation
• n / Procedur

dure/ e/ Medicine ne/ ICU and room. Reque uest the Hospital to apply CGHS rates for Consul ultation/

• n/ Inves

estigation

• n / Procedu

edure/ e/ Medicine ne/ ICU / room and send the bill for Claim processing ng and settlem emen

• ent. Reque

uest the Hospitals to send the Doctor`s `s Ethical Certificate e to justify fy, admission,

• n, investigation,

n, medication,

• n, procedur

dure e and the Costs. Anyuta Format is enclos

• sed

ed here with for you to send it to all empane neled ed hospitals. With this method d there will not be any delay in claim processing ng and settlem emen

• ent. This will also
• save

e revenu enue e for the ABY Scheme. e.

• Sl. No

Name Procedure done Claimed Amount Settled Amount Hospital Remarks 1 Ashok B Wajre Elective Coronary Artery Bypass Grafting X LIMA - OM, RSGV- LAD/PDA/ PLV Narayana Hrudayalaya The Bill states the Procedure is SPONSORED Please find out from the Hospital who was the SPONSORER and has he paid in full. CGHS has separate rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room. Request the Hospital to apply CGHS rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and send a fresh bill for Claim processing and settlement. 2 Revanna H N Conservative Line Of Treatment Mangala Hospital Can be settled CGHS has separate rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room. Request the Hospital to apply CGHS rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and send a fresh bill for Claim processing and settlement.

20 20 Shiv Shankar r Gowda CS CS Dialys ysis Appol

• lo

Chronic disease needs repeated admission and treatment and sometimes life long, like kidney failure / Cancer/ Heart disease / Neurological disorder Haemodialysis @ Basic Cost + 20% Our advice is negotiate with the hospital for a package rate as mentioned above 21 21 Tanuja Kolkar Dialysis Shakunthala Memorial Hospital & research Centre Haemodialysis @ Basic Cost + 20% Cancer @ @ Basic Cost + 20% Our advice is negotiate with the hospital for a package rate as advised above 22 22 Dakshayani Medical management BGS Global Hospital Can be settled Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim 23 23 Ganesh Krupa V MRI-Spine Suguna Hospital Can be settled Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim 24 24 Gopal Krishna DJ Stent Removal Under LA Suguna Hospital DJ Stent Removal Under LA. Could have been done as an outpatient procedure? We need doctor’s ethical certificate to process This file ethical certificate enclosed email. None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs) 25 25 Gowrishree Conservative Line Of Treatment Suguna Hospital Could this have been treated as Outpatient? We want doctor`s ethical certificate for justify investigation of the cost to process and settle the claims. None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs) 26 26 Gururaja Raos N Conservative Line Of Treatment Apollo BGS Hospital None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs)

27 27 Jayalaksh shmi Medica cal Managem gemen ent G S M Can be settl tled Request est the Hospit pital to send a bill applyi ying g CGHS Code and rates s for Consu sulta tati tion

• n/

/ Investi estiga gati tion

• n / Proce

cedure/ / Medicine/ / ICU and room and settl tle the Claim 28 28 Jayamma Apollo BGS Hospital Patient was admitted for 5 days and expired. The total bill amount is 1,43,380/- We advise to request the hospital to reduce the cost. 29 29 Padmaja K 1 ESWL Lithotripsy Hitech Kidney stone Hospital Can be settled Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim 30 30 Padmaja K 2 Flush Therapy Suguna Hospital Discharge against medical advice We need an Ethical certificate signed by the primary physician who admitted patient stating the admission was needed and the cost is Genuine. None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs) 31 31 Ranganath Medical Management Suguna Hospital Can be settled Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim 32 32 Shankar M R Bilateral stenting Under SA Suguna Hospital Patient is admitted for Right Ureteric Calculi We want doctor`s ethical certificate for justify investigation of the cost to process and settle the claims. None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs) 33 33 Sundar M R Medical Management Suguna Hospital Can be settled Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim 34 34 Venkata Krishnaiah Medical Management BGS Global Hospital Patient admitted on 18/10/12 discharge 19/10/12 against medical advice. We need doctor`s ethical certificate for justify investigation of the cost to process and clear the bill. None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs)

NOTE : These se patien ents s are treated for Malignancy y / Chroni

• nic disease

se requiri ring prolong

• nged

ed treatmen ent. Chronic disease needs repeated admission and treatment and sometimes life long, like kidney failure / Cancer/ Heart disease / Neurological disorder. CGHS has separate rates for Consultation/ Investigation / Procedure/ Medicine/ ICU / Chemo & Radiotherapy and room. Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ Investigation / Procedure/ Medicine/ ICU /Chemo & Radiotherapy/ room , etc, then settle the Claim using the formulae given below after negotiation with the Hospitals. Radiotherapy / Chemotherapy @ Basic Cost + 20% Our advice is negotiate with the hospital for a package rate as mentioned above

• Sl. No Name

Procedure done Claimed Amount Settled Amount Hospital Remarks 1 Dakshina Murthy Intensity Modulated Radiation Therapy 1,10,770 Bangalore Institute of Oncology This patient is for chemotherapy We need the details of the disease , Line of treatment , cost involved to process and settle this claim We need Doctors ethical certificate 2 Dakshina Murthy Brainsten Glioma For Supportive Care 3,00,326 Bangalore Institute of Oncology This patient is for chemotherapy We need the details of the disease , Line of treatment , cost involved to process and settle this claim We need Doctors ethical certificate 3 A Sagai Upper GI Endoscopy With Biopsy 1,13,400 Bangalore Institute of Oncology We need the details of the disease , Line of treatment , cost involved to process and settle this claim We need Doctors ethical certificate 4 Nagalakshmi 21,200 Bangalore Institute of Oncology This patient is for chemotherapy 5 Nagalakshmi 35,310 Bangalore Institute of Oncology We need the details of the disease , Line of treatment , cost involved to process and settle this claim 6 Nagalakshmi 17,185 Bangalore Institute of Oncology We need Doctors ethical certificate 7 Nagalakshmi 31,208 Bangalore Institute of Oncology This patient is for chemotherapy 8 Nagalakshmi 5,805 Bangalore Institute of Oncology We need the details of the disease , Line of treatment , cost involved to process and settle this claim 9 Nagalakshmi 35,813 Bangalore Institute of Oncology We need Doctors ethical certificate 10 10 Nagalakshmi 22,975 Bangalore Institute of Oncology This patient is for chemotherapy 11 11 Nagalakshmi 33,214 Bangalore Institute of Oncology We need the details of the disease , Line of treatment , cost involved to process and settle this claim 12 12 Nagalakshmi 25,624 Bangalore Institute of Oncology We need Doctors ethical certificate 13 13 Nagalakshmi 14,822 Bangalore Institute of Oncology This patient is for chemotherapy